Provider Demographics
NPI:1033121017
Name:COMBS-WOOLUM, MARTHA C (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:C
Last Name:COMBS-WOOLUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-0040
Mailing Address - Country:US
Mailing Address - Phone:606-633-4823
Mailing Address - Fax:
Practice Address - Street 1:251 S PINE ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1646
Practice Address - Country:US
Practice Address - Phone:606-337-3500
Practice Address - Fax:606-337-5233
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64262124Medicaid
F54314Medicare UPIN
KY0700801Medicare ID - Type Unspecified